IV Medication Principles

Question 1

Common vein used for peripheral venous catheters

Answer 1

cephalic veins

Question 2

Limitations of peripheral lines

Answer 2

-phlebitis (vein irritation)
-thrombosis
-interstitial fluid extravasation (when it becomes dislodged from the vein and infusion enters surrounding tissue)

Question 3

Uses for a central Line

Answer 3

-highly concentrated drugs
(potassium chloride greater than 20 mEq/L)
-long-term antibiotics
-toxic drugs like chemotherapy with vesicants
-drug with pH or osmolarity different from blood (parenteral nutrition)

Question 4

extravaste

Answer 4

when a catheter tip comes out of the vein and into the surrounding tissue

Question 5

examples of vesicants

Answer 5

-vasopressors (DO, NE)
-anthracyclines (doxorubicin)
-vincalkoloids (vincristine, vinblastine)
-digoxin
-foscarnet
-nafcillin
-mannitol
-mitomycin
-promethazine

Question 6

Promethazine IV

Answer 6

-can cause severe tissue injury
-IM preferred but risk still remains
-if using IV, dilute and limit use
-do not give to children under 2 years of age

Question 7

Chemical incompatibility

Answer 7

drug degradation or toxicity due to:
-hydrolysis
-oxidation
-decomposition

Question 8

Physical incompatibilities

Answer 8

-the container (polyvinyl chloride)
-diluent (dextrose or saline)
-another drug

Question 9

DEHP

Answer 9

-diethylhexyl phthalate (DEHP)
-used in PVC (polyvinyl chloride containers) as a “plasticizer” to make it more flexible
-it can leach into solution
-toxic to liver and testes

Question 10

Alternative Non-PVC Containers

Answer 10

-polyolefin
-polypropylene
-glass

Question 11

Drugs with leaching/adsorption/absorption issues with PVC Containers

Answer 11

“Leach absorbs to take in nutrients”
-lorazepam
-amiodarone
-tacrolimus
-taxanes
-insulin
-nitroglycerin

others: carmustine, cyclosporine, lxabepilone. sufentanil, temsirolimus

*taxanes exception:
paclitaxel-albumin bound (Abraxane) can be placed into PVC container

Question 12

Drugs that are compatible with saline (No dextrose)

Answer 12

A DIAbetic Can’t Eat Pie
-Ampicillin
-Daptomycin (Cubicin)
-Infliximab (Remicade)
-Ampicillin/Sulbactam (Unasyn)
-Caspofungin (Cancidas)
-Ertapenem (Invanz)
-Phenytoin (Dilantin)

Others:
Abatacept, azacitidine, belimumab, bevacizumab, idraucizumab, iron sucrose, ferric gluconate, natalizumab, trastuzumab

Question 13

Drugs that are compatible with dextrose (No saline)

Answer 13

Outrageous Bakers Avoid Salt
-Oxaliplatin
-Bactrim
-Amphotericin B
-Synercid: Quinupristin/ Dalfopristin

Others:
-Carfilzomib
-Mycophenolate
-Pentamidine

Question 14

High Risk Incompatibilites

Answer 14

Ceftriaxone and calcium containing products (lactated ringers)

Calcium and phosphate (often found in TPN and must be addressed)

Question 15

Drug Compatibility Resources

Answer 15

-ASHP Injectable Drug Information
-Trissel’s 2 Clinical Pharmaceutics Database
-King Guide to Parenteral Admixtures
-Drug package insert

Question 16

most common filter size needed for most drugs

Answer 16

0.22 micron filter
(1 micron = 1/1,000 mm)

Parenteral nutrition uses a 1.2 micron filter for the calcium phosphate particulates

-large molecule liposomal formulations cannot be filtered!

Question 17

Common drug with filter requirments

Answer 17

my GAL Is PAT who has a MaP

-golimumab
-Amphotericin B (lipid formulations need a 5micron filter)
-Lipids -1.2 microns
-ISavuconazonium
-phenytoin (when administered by continuous infusion, not IV push)
-Amiodarone
-Taxanes (cabazitaxel and paclitaxel)
-Mannitol 20% or greater
-Parenteral nutrition: 1.2 microns

Others:
-Abatacept
-Albumin
-Infliximab

Question 18

Two key drugs that crystallize when kept cold

Answer 18

furosemide and phenytoin

Question 19

Key drugs DO NOT REFRIGERATE

Answer 19

Dear Sweet Pharmacist, Freezing Makes Me Edgy!

-Dexmedetomidine *but not if diluted
-SMX/TMP
-Phenytoin -crystal
-Furosemide-crystal *but not if diluted
-Metronidazole
-Moxifloxacin
-Enoxaparin

Others:
Acetaminophen, Acyclovir (crystal), deferoxamine (precipitates), levetiracetam, pentamidine (crystal), valproate

Question 20

Protect from light during administration

Answer 20

Protect Every Necessary Med from Daylight
-Phytonadione (vitamin K)
-Epoprostenol
-Nitroprusside
-Micafungin
-Doxycycline

Others:
Amphotericin B, Deoxycholate, Anthracyclines, Dacarbazine, Pentamidine

Question 21

Products that foam and need to be swirled when reconstituting

Answer 21

-alteplase
-etanercept (Enbrel)
-rasburicase
-quinupristin/dalfopristin (Synercid)
-caspofungin

Question 22

What does discoloration indicate?

Answer 22

oxidation or another form of decomposition

Question 23

Dobutamine color change

Answer 23

oxidation turns the slightly slightly pink BUT POTENCY IS NOT LOST

Question 24

Nitroprusside color change

Answer 24

orange –> brown –> blue
*blue indicates complete dissociation into CYANIDE

Question 25

IV drugs that come colored

Answer 25

Anthracyclines (doxorubicin): RED
Rifampin: RED
Mitoxantrone: BLUE